Benchmarking for Day and Short Stay Surgery

Mark Skues Editor, Journal of One-day Surgery President Elect, BADS

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Making Day Surgery Count

BADS has been involved with 21 years of: Recommendations Benchmarks Targets

Where are we now?

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Link with ERP

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Guidance from the RCS

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The abstract...

Journal of One Day Surgery 2010;20.3:(Suppl)

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Just a few of the publications

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Back to the last Millennium...

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The Audit Commission Basket of Procedures 1990

Orchidopexy Inguinal hernia repair Anal Fissure excision Cystoscopy Carpal Tunnel Decompression Arthroscopy of Knee Squint correction Sub Mucous Resection Pinnaplasty Laparoscopy + Sterilisation
British Association of Day Surgery

Circumcision Excision of breast lump Varicose veins Dupuytrens contracture Ganglion excision Cataract removal Myringotomy MUA # Nose D&C Termination of Pregnancy
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Audit Commission Basket of 25 Procedures (2000)

Orchidopexy Inguinal hernia repair Anal Fissure Lap Cholecystectomy TURBT Carpal Tunnel Release Arthroscopy of Knee Removal of metalware Squint correction Tonsillectomy MUA # Nose D&C, Hysteroscopy Termination of pregnancy
British Association of Day Surgery

Circumcision Excision of breast lump Haemorrhoidectomy Varicose veins Dupuytrens contracture Ganglion excision Bunion operations Cataract removal Myringotomy + Grommet Sub Mucous Resection Pinnaplasty Diagnostic Laparoscopy

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The NHS Plan (2000)

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Day Surgery Department of Health,

2002

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The Upper Quartile?

Inguinal Hernia Repair

52% 43% 33%

75th percentile British Association of Day Surgery

Median

25th percentile www.bads.co.uk

Day Case Laparoscopic Cholecystectomy 1999-2000

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Day Case Laparoscopic Cholecystectomy 2008-09 Acute

80 70

Teaching

60

50 DC rate (%)

40

30

Why the variation?

20

10

0 Rank order

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Where are we now?...

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The BADS Procedure Directory

Time to move away from the Basket..
Sub-optimal cross coding to OPCS Not comparable across all Trusts Advances in surgical and anaesthetic techniques Has given the impression that the Basket of 25 are the only procedures to concentrate on
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The BADS Procedure Directory

2006
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2007

2009
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Procedure Directory rd 3 Edition

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BADS Procedure Directory

Some procedures may need longer recovery
or observation times

Others may required specialised equipment

or training for Clinicians to achieve their full potential require: Reconfiguration of day surgery lists Redesign of the clinical pathway Investment in appropriate technology

Therefore, achievement of these goals may

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Day Surgery is a planned pathway

GP Referral Surgical Outpatient Management Process Appointment Pre-Op Assessment On the day Care Home Discharge Home follow-up

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BADS Procedure Directory

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Day Case Rates for Mastectomy in England 2008-9

100 90

80

70

60 DC rate (%)

50

40

30

20

10

0
Trusts in England

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How do we update benchmarks?

Collaboration with external organisations: Audit Commission Payment by Results Tariff Team NHS Information Centre (HES data) NHS Institute Better Care indices Wales Audit Office
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How do we update benchmarks?

Collaboration with Individuals and Professional Organisations; Gynaecology and the RCO&G Paediatric Surgery and APA Trusts: BADS Efficiency Assessment Tool
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British Association of Day Surgery

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BEAT

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Is this good or bad?

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Comparative benchmarking

Basket of 25 Scores:

82%

89%

73%
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Use of the Procedure Directory

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Simple Mastectomy (2008-9)

8

Breast05: Simple mastectomy (including axillary node biopsy) (opportunity = 158 BDs pa)

5 LoS (days) Acute Teaching Target (LQ) LoS COUNTESS OF CHESTER HOSPITAL FT RJR

0 0 10 20 30 40 DC rate (%) 50 60 70 80

Excess of bed nights = 158 @ 300 per night = 47,500

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And, finally....

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Day Case rates in England HES Data

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The NHS Plan envisages that 75% of all Elective Surgery will be carried out as a day case in the near future

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But....
This data includes diagnostics and non surgical interventions... Endoscopy Radiology Transfusion

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The NHS Plan envisages that 75% of all Elective Surgery will be carried out as a day case in the near future

Defn: near future = 2032

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Tariff incentivisation for 2011-12

Enhanced reimbursement for Breast Surgery Hernia Surgery Orthopaedic Forefoot Surgery If performed as Day Case
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British Association of Day Surgery

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Benchmarking for Day and Short Stay Surgery

Mark Skues Editor, Journal of One-day Surgery President Elect, BADS

British Association of Day Surgery www.bads.co.uk